10D2188590 CLIA NUMBER - WAL-MART STORES EAST LP

Laboratory Demographics

CLIA Number: 10D2188590

Facility Name: WAL-MART STORES EAST LP

Facility Address:
19975 S TAMIAMI TRAIL
ESTERO, FL
ZIP 33928
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Facility Phone Number: 239 590-9506

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1518346071

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	10D2188590
LAB Type	Pharmacy
Facility Name	WAL-MART STORES EAST LP
Street	19975 S TAMIAMI TRAIL
City	ESTERO
State	FL
ZIP	33928
Phone	239 590-9506
CertificateType	4
CertificateEffectiveDate	7/20/2022
CertificateExpirationDate	7/19/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024